Surgical treatment of persistent elbow epicondylitis.

From 1978 through 1987, 86 patients with epicondylitis were admitted for surgery after failed conservative treatment. The Wilhelm technique was performed either alone or in combination with an intraarticular procedure. The Wilhelm technique involves denervation of the epicondyle. The intraarticular procedure described by Bosworth or Boyd involves a one-third resection of the orbicular ligament and resection of a synovial fold. Before surgery a local anesthetic was injected at the sore spot of the epicondyle. After almost complete pain relief after injection, a sole Wilhelm procedure was performed at the lateral epicondyle in 34 patients and at the medial epicondyle in 17 patients. For 27 patients in whom the pain persisted after the injection, a combined Wilhelm and intraarticular procedure using the Bosworth or Boyd method was used. Degeneration of the orbicular ligament or a redundant synovial fold was reported in 77% of the intraarticular operation reports. At a follow-up examination, a minimum of two years and an average of four years nine months after surgery, 85% had good and excellent results after lateral and medial Wilhelm and 56% after combined surgeries while the poor results were 3% and 7% respectively. The results of combined surgery worsened from discharge to follow-up examination, and they show fewer good results than those where a sole Wilhelm procedure was performed. Therefore, intraarticular surgery should be considered for patients with incomplete pain relief after a test injection, but it should not routinely be performed.